Community Stroke Interventions Do Not Address Participation and Environment for Stroke Survivors: Exploring Stroke Self-management Interventions Using the ICF Framework

Research Objectives: 1) To assess community-based stroke interventions against a set of domains evidenced to improve self-efficacy and self-management. 2) To identify self-management domains that are measured more frequently than others. 3) To consider the results within the context of the International Classification of Function, Disability, and Health Framework (ICF).

Design: Analysis of extracted data (measures used) from a larger scoping review of existing community-based interventions for people with stroke and/or stroke caregivers. 105 intervention studies are included in this data sub-analysis. The Rehabilitation Measures Database (rehabmeasures.org) was used to identify the domain for each extracted measure. Measures were categorized into one of nine domains evidenced to promote self-efficacy and chronic disease self-management. The frequency of each domain was then assessed, and results were displayed in relation to the ICF framework.

Setting: Community and outpatient settings.

Participants: Community-based intervention studies that addressed coping after returning home following stroke. Study participants were adults with diagnosis of stroke (and/or stroke caregivers).

Interventions: A data subset of 535 measures used in 105 studies were analyzed against evidence-based intervention domains for self-efficacy and self-management using a two-reviewer process. Measures were sorted into CDSMP domains, and the results were assessed against the ICF categories.

Main Outcome Measures: Frequencies of each Stanford CDSMP domain / Key Determinant of Health domain. Secondary measure: Frequency of each ICF category.

Results: Almost half of the measures addressed behavior (45.8%, 245/535). Less than 30% of the measures addressed socio-cultural contexts (23.7%, 127/535) or coping response (18.9%, 101/535). Few study measures addressed peers and family (7.3%, 39/535) or the cognitive processes involved in self-management, which include decision making, resource utilization, problem solving, self tailoring, and action planning (4.3%, 23/535). Further, approximately half of the measures addressed the ICF framework domain of body structure and function (50.1%, 268/535), less than half of measures addressed personal factors (42.6%, 228/535), and few addressed participation and environment (7.3%, 39/535).

Conclusions: Measures of participation, social roles, and environmental factors were seldom used in stroke CDSMP studies, which is similar to the gap often identified in rehabilitation studies. Further, no measures of patient-provider relationship were identified in our data results, which indicates an opportunity to focus on patient-provider relationship intervention components in stroke CDSMPs.

Author(s) Disclosures: None